Document Detail

Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure.
MedLine Citation:
PMID:  15668765     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: In patients with severe brain injury and acute lung injury the use of positive end-expiratory pressure (PEEP) is limited by conflicting results on its effect on intracranial pressure. We hypothesised that the occurrence of alveolar hyperinflation during the application of PEEP would lead to an increase in PaCO(2) responsible for a rise in intracranial pressure. DESIGN: Prospective interventional study. SETTING: Intensive Care Unit of University Hospitals. PATIENTS AND PARTICIPANTS: Twelve severely brain-injured patients with acute lung injury and intracranial pressure higher than applied PEEP. INTERVENTIONS: 5 and 10 cmH(2)O of PEEP was randomly applied. MEASUREMENTS AND RESULTS: In all patients intracranial pressure, flow velocity by transcranial Doppler of middle cerebral artery, and jugular oxygen saturation were recorded. Static volume-pressure curves of the respiratory system were obtained, recruited volume and elastance calculated to classify patients as recruiters and non-recruiters. In recruiters (= 6 patients), elastance decreased (P<0.01) and PaO(2) increased (P<0.005), while in non-recruiters (= 6 patients) elastance and PaCO(2) significantly increased (P<0.001). Intracranial pressure, Doppler flow velocity, and jugular saturation remained constant in recruiters but significantly increased (P<0.0001) in non-recruiters. A significant correlation was found between changes in intracranial pressure and elastance (r(2) = 0.8 P<0.0001) and between changes in PaCO(2) and intracranial pressure (P<0.001, r(2) = 0.4) and elastance (P<0.001, r(2) = 0.4), respectively. CONCLUSIONS: When PEEP induced alveolar hyperinflation leading to a significant increase in PaCO(2), intracranial pressure significantly increased, whereas when PEEP caused alveolar recruitment intracranial pressure did not change.
Luciana Mascia; Salvatore Grasso; Tommaso Fiore; Francesco Bruno; Maurizio Berardino; Alessandro Ducati
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2005-01-25
Journal Detail:
Title:  Intensive care medicine     Volume:  31     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-07     Completed Date:  2005-08-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  373-9     Citation Subset:  IM    
Università di Torino, Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Ospedale S. Giovanni Battista, Italy.
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MeSH Terms
Aged, 80 and over
Brain Injuries / complications,  physiopathology*,  therapy*
Carbon Dioxide / metabolism
Intracranial Hypertension / etiology*,  metabolism
Lung Volume Measurements
Middle Aged
Partial Pressure
Positive-Pressure Respiration / methods*
Respiratory Distress Syndrome, Adult / diagnosis,  etiology,  physiopathology*,  therapy*
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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